SSRIs (FFPECS) – 1st SNRIs DNRIs – atypical SARIs TCAs (You’re “trip-pin” MAOIs (TIPS)

line antidepressant if you thinking about RX

a TCA
Fluoxetine (Prozac) Venlafaxine Bupropion Trazodone Nortriptyline (Pamelor) Selective MAO-A
Fluvoxamine (Luvox) (Eexor) (Wellbutrin) (TraZZZZo- Amitriptyline (Elavil) inhibitors - dx
(Zyban): Zyban Tranylcypromine
Paroxetine (Paxil): Desvenlafaxine is usually
BONE) Imipramine (Tofranil) (Parnate)
Often used (Pristiq) prescribed for Vilazodone Clomipramine Isocarboxazid
to treat certain Duloxetine smoking (Viibryd) Amoxapine (Asendin). (Marplan
anxiety (Cymbalta): cessation - Vortioxetine Desipramine Phenelzine
disorders Most frequently Wellbutrin is (Trintellix) (Norpramin). (Nardil)
highly e3ective -
Escitalopram used. Can also be Doxepin (Silenor). Phenelzine has
does not have
(Lexapro) RX for nerve the sexual side Acts on the Protriptyline (Vivactil®). been shown to be
Citalopram (Celexa) pain. e3ects Alpha – Trimipramine more e3ective
Sertraline (Zoloft) Levomilnacipran adrenergic (Surmontil®). than placebo for
receptors MDD w/ atypical
Milnacipran
features, MDD
w/ psychotic
features and
social phobia.

Selective MAO-B
inhibitors –
Parkinson’s
Selegiline
(Emsam)
Transdermal
Patch
DOES NOT
REQUIRE
DIETARY
RESTRICTION
6mg/24hr or
lower

MDD (unipolar) MDD (unipolar) MDD Used for MDD, 2nd line depression Only used for refractory
classes when other meds
GAD, panic dx, GAD, panic dx, ADHD anxiety and MDD (unipolar) – Must try have failed
PMS, PDD, PTSD PTSD, Smoking insomnia and fail multiple class of Depression (not

1
OCD, Depression cessation antidepressant before 1st line)
Bulimia (Fluoxetine) Chronic Pain Sexual Main SE: trying these meds Panic Dx, Social anxiety,
bulimia nervosa
syndrome (diabetic dysfunction nausea, Diabetic neuropathy Treatment:
peripheral Appetite dizziness, Migraine Prophylaxis
Parkinson’s DX
neuropathy, suppressant orthostatic Nocturnal enuresis
Selegiline
Bbromyalgia, hypotension, Postherpetic neuralgia
chronic sedation, (Emsam) –
musculoskeletal Priapism Transdermal
pain) (prolonged Patch
These patients need the
erection) Dopamine NOT
TYPICALLY USED
Low doses for FOR DEPRESSION
sleep (50mg),
higher doses
Last resort
antidepressant secondary to
e3ects dangerous food
and drug
interactions

Used in
refractory cases
of depression

Food restriction:
Follow Tyramine
free diet

Tyramine rich
foods:
red wine, aged
cheese, chicken
liver, fava beans,
cured
meats

SE: Insomnia,
weight gain,
Anticholinergic,
2
 sexual SE,
orthostatic
hypotension,
photophobia,
drowsiness,
sleep
dysfunction

Liver toxicity,
seizures and
edema (rare)

Require
washout
period of 5
half
-lives when
switching

Very dangerous
interactions with
other
antidepressants
and opioids, risk
of serotonin
syndrome

↑ risk of suicidal ↑ risk of suicidal Side Eects: Sedation (H1) TCAs Hypertensive
ideation (adolescents & ideation Headache, - Cardiac: Cardiotoxicity Crisis (Tyramine
tremors, Priaprism
kids) (adolescents & tachycardia, (TraZZZZo- (arrhythmias) rich foods & drinks)
QTC prolongation kids) insomnia, anxiety, - Cutie (QT prolongation)  Chest pain
BONE)  Shortness of
- Citalopram (ECG) Hypertension d/t decreased - Chubby (weight gain)
Sexual dysfunction NE appetite - Convulsions breath
 Headache
Serotonin syndrome - Anti-Cholinergic
 Blurred
“SHIVERS” QTC prolongation Most helpful for - Coma (caution with vision
Hyponatremia Sexual dysfunction target sx cardiac patients)
3
 Weight gain Serotonin of low energy,  Nausea and
- Fluoxetine (least) syndrome anhedonia, low vomiting
concentration, or if Anxiety
- Paroxetine (most) “SHIVERS” having sexual s/e T achycardia 
Nausea Hyponatremia C ardiac e3ects ( ↑QTC,  Dizziness
from SSR
 Decreased
Headache Nausea arrhythmias)
urine output
Agitation Headache A nticholinergic e3ects  Heart
Hyponatremia Weight neutral
S exual palpitations
Etiology: Excess. Serotonin dysfunction/sedation  Nosebleed
in the body (single or S hivering Contraindicated in
multiple serotonergic iNCREASED
agents) H yperreJexia/ patients with Tyramine rich
Myoclonus seizure and eating APPETITE Side Eects ( 3 A’s
disorders= Lowers foods: aged
S hivering I ncreased Temp seizure threshold -SEDATION Anticholinergic/ cheeses,
H yperreJexia/ V ital sign (at higher doses) -DRY MOUTH Antimuscarinic: sauerkraut, cured
Myoclonus instability dry mouth, blurred vision, meats, draft beer
I ncreased Temp (fever) E ncelopathy •Lacks sexual side constipation, memory and fermented
e3ects –add to
V ital sign instability R estlessness problems, urinary soy products,
other
( ↑↓BP; S weating antidepressants to retention (Ach), narrow Beer, red wine,
↑RR; ↑HR) angle glaucoma
txt sexual meat, poultry,
E ncephalopathy Serotonin dysfunction Antiadrenergic:
(confusion)
Bsh,
Syndrome (SS): Hypotension( postural Serotonin
R estlessness •Other available
Rarely caused from forms: XR= 24
hypopentension), syndrome
S weating (Diaphoresis)
1 drug- typically a hours; SR= 12 orthostasis; dizziness,
- Much more
combination hours reJex tachycardia,
Progression: (each drug adds a arrhythmias, ECG changes
severe
Rhabdomyolysis, renal little more •Less GI distress –avoid in patients with pre Do not mix
failure, convulsions, serotonin). -existing conduction SSRI and
•Side e3ects:
oma= · Mild symptoms: abnormalities or recent MI MAOIs
agitation,
DEATH high body jitteriness, mild Antihistaminic: SHIVERS
Txt temperature, cog dysfunctions, sedation weight gain S hivering
1. Stop medication insomnia H yperreJexia/
2. Supportive care agitation,
increased reJexes, EKG changes and Cardiac Myoclonus
3. Cyproheptadine (5HT
I ncreased Temp
antagonist) tremor, dysrhythmias
4. ECT in emergencies V ital sign
sweating, dilated Seizure risk –related to the instability
pupils, & diarrhea dose and serum level E ncelopathy
· Severe R estlessness
symptoms: muscle Lethal in overdose (give S weating
Sexual dysfunction (30 rigidity, fever, & 1
-40%) seizures -week prescription
decreased libido, especially in high -risk
anorgasmia, delayed
4
ejaculation –occurs patients);
weeks to months Desipramine is the most
(typically do not Benzodiazepine lethal
resolve) meds
(diazepam/Valium
GI (nausea/diarrhea) or TCA overdose= gastric
-Give w/ food, lorazepam/Ativan) aspiration is helpful,
insomnia, headaches, decrease agitation, cardiac monitoring is
anorexia/weight loss, seizure like important
Akathisia, sedation, movements, &
agitation, muscle sti3ness. LOW BLOOD PRESSURE ON
Hyponatremia / SIADH, -Cyproheptadine STANDING, INCREASED
decreased platelet (Periactin) blocks HEART RATE ,SEXUAL
aggregation-risk serotonin DYSFUNCTIONS
for bleeding and production **incredibly drying in all
bruising · Tx: mucous membranes
Seizures-rare benzodiazepines & TCA overdose *high
decrease other potential*
BLACKBOX meds D ilated pupils
WARNING: Increased D ry mouth
suicidality in D ry Jushed skin
children, D isability to completey
adolescents and empty the bladder (urine
young adults Duloxetine retention)
(Cymbalta) 40 D rowsiness
NOTE: -120mg/day D ecreased BP
Remember FFPECS • Can increase LFTs D uration of QRS complex
•Used for is
DROWSINESS depression, Prolonged
INSOMNIA neuropathic pain
NERVOUSNESS and in Bbromyalgia Seizure – Tx: Benzo’s
AGITATION OR •Hepatotoxicity QT prolongation
RESTLESSNESS - (monitor LFTs)
SEXUAL TX: NA BICARBONATE
DYSFUNCTIONS -DRY (tx of cardiac toxicity)
MOUTH ***if keep “A Tricycle is a Small
taking medication side Bicycle”
e3ects should get TCA overdose = Sodium
better or go away Bicarbonate

5
SSRI SEXUAL SIDE
EFFECTS Desire (libido)
Frequency of sexual
activity Antidepressant
Arousal (lubrication in Withdrawal /
Discontinuation
females and erectile Syndrome “FINISH”
function in males) F= Flu like symptoms
Orgasm (delayed (aches, pains, chills)
orgasm and I= Insomnia
N= NauseaI=
anorgasmia) Imbalance
Management S= Sensory
Watchful waiting; if disturbance (tremors,
sexual impairment sensation of electrical
persists: shock)
H= Hyperarousal
•Decrease the dose of
the SSRI within the •Gradual taper of
therapeutic range. medications •Least
Switch to Bupropion likely with
Fluoxetine and
(Wellbutrin)
Vortioxetine
phosphodiesterase-5 (Trintellix/Brintellix)-
inhibitor. may consider short
trial to mitigate
symptoms
•Symptoms usually
begin within 5 days of
treatment cessation
•Consider a 4-week
taper (longer with Paxil
and E3exor
Activating H ypotension
Antidepressants – A nticholinergic side
e3ects
good for patients who H ypertensice crisis
want to avoid (avoid tyramine)
medications that A nxiety, agitation,
cause tiredness –e.g. anorexia
Fluoxetine –Sertraline
Usually Brst
---Escitalopram – classiBcation
E3exor ( symptoms of medication
restlessness, prescribed
6
agitation, for major depressive
anxiety)•Sedating: dx
-SigniBcant food
Fluvoxamine, and drug
Paroxetine interactions
Maintenance for MDD (tyramine)
treatment = at least -Strong drug-drug
6 months (Up to 1 interactions with
OTC
year) Most lethal cold and Ju
SSRI in overdose = medications----can
Citalopram cause serious
(Celexa)•Associated hypertensive crisis
with dose dependent
QTC prolongation in
doses 40+mg •Max
dose in Geriatrics=
20mg

SSRIs SNRIs DNRIs SARIs TCAs – inhibit SER & NE MAOIs

Sertraline Duloxetine Clomipramine – OCD

SQUIRTLINE “DUALoxetine” Amitriptyline – migraines
- GYCOMNESTIA (SR, NR) Imipramine (I’ma
- SAFE IN DULLoxetine PEEING)– nocturnal
7
 PREGNANCY/BREA (pain) enuresis (not Brst line tx
ST FEEDING – Desmopressin is
- GI side e3ects
Fluoxetine
(FluOXtine- BULimia)

FGAs - typical SGAS- atypical – 1st Norepinephrine and

line tx Serotonin speciBc
schizophrenia receptor
Chlorpromazine Aripiprazole Clozapine -Common Mirtazapine
Droperidol (Abilify), Asenapine adverse e3ects (Remeron) atypical
8
Fluphenazine (Saphris), •HTN antidepressant
Haloperidol Brexpiprazole •Hypotension TX of a major
depressive dx
Loxapine (Rexulti), •Tachycardia Mirtazapine inhibits the
Perphenazine Cariprazine •Dyslipidemia central presynaptic
Pimozide (Vraylar), •Weight gain alpha-2-adrenergic
Prochlorperazine Clozapine •Constipation receptors, which causes
Thioridazine (Clozaril), •Sialorrhea an increased release of
serotonin and
Thiothixene Iloperidone •Drowsiness/sedation norepinephrine.
TriJuoperazine (Fanapt),
Lurasidone
(Latuda),
Olanzapine
(Zyprexa),
Paliperidone
(Invega),
Risperidone
(Risperdal),
Quetiapine
(Seroquel),
Ziprasidone
(Geodon).
-ONLY TARGET Used to treat refractory
POSITIVE schizophrenia (i.e.,
SYMPTOMS; but treatment resistant)
doesn’t Only antipsychotic
do much for the shown to decrease SI
negative risk
symptoms •Less likely to cause TD
-USUALLY NOT THE •Weight gain is most
FIRST prominent
CHOICE FOR •More anticholinergic s/e-
TREATMENT tachycardia, constipation
primarily block etc. •Hypersalivation
dopamine (sialorrhea) occurs in 30-
80%
Olanzapine – 1st •Agranulocytosis (highest
9
 line schizophrenia. Brst 3 months of
May cause obesity treatment)= Monitor
WBC and Absolute
neutrophil count (ANC)
•D/C med if ANC is <1.5
(1500)
•ANC
General Management of
Sialorrhea
-Chew sugarless gum
-Place towel over pillow
especially if nocturnal
sialorrhea is a problem
-Med: Glycopyrrolate
(Robinul) -fewer
Anticholinergic side
e3ects)-Benztropine,
Artane etc.

Introduced in the First line treatment Pimavanserin=Nuplazid=

1950’s •Fewer Used in Parkinson’s
•Block D2 receptors neurological S/E related psychosis (newer
•E3ective for positive •E3ective for both med)
symptoms positive and
•Can worsen negative negative
symptoms secondary to symptoms
↓DA in the Mesocortical •Serotonin-
pathway Dopamine
•Long-acting forms antagonist
available (Decanoate (D2/5HT2A)
•Can cause EPS
Typical Antipsychotic side but at a lower risk
E3ects (blockade of •↓ incidence of
histamine, acetylcholine, Tardive dyskinesia
alpha 1 and other •Metabolic side
receptors)
eects: Weight

10
1. High antiadrenergic, gain, HLD,
anticholinergic and hyperglycemia,
antihistaminic s/e (e.g. Diabetes, HTN,
sedation, weight gain Cardiac and
(like 30 lbs in 6 weeks) respiratory S/E
•Some
Antihistaminic,
2. Elevated liver enzymes,
jaundice
antiadrenergic and
antimuscarinic
3. Seizures –all e3ects •Elevated
antipsychotics lower the Liver function tests
seizure threshold (LFTs)-check yearly
•QTC Prolongation
4. Orthostatic
hypotension NOTE:
Antipsychotics can
5. QTC prolongation – take up to 6-8
obtain baseline EKG
weeks for response
6. Sexual dysfunction Metabolic
Syndrome
7. Rashes, H1 receptor
photosensitivity antagonism is
associated with
8. Elevated liver enzymes, sedation and
EPS (Akathisia, dystonia, weight gain
Parkinsonism)
❖Weight gain
9. **Hyperprolactinemia –Metformin can be
(decreased libido,
used to reduce or
galactorrhea, prevent
gynecomastia,
impotence, ❖Hyperlipidemia
amenorrhea) ❖Hyperglycemia
10. Tardive dyskinesia Monitor Baseline
and ongoing(i.e. 3
11
11. Neuroleptic months etc.)
Malignant Syndrome
(FALTERED) Weight
Waist
Neuroleptic circumference
Malignant Syndrome BP
(NMS) – Life-threatening HbA1c
idiopathic reaction to Fasting lipids
antipsychotic medications
(more common w/ FGAs)
**Medical Emergency
NOTE: For patients
w/ 20% mortality rate if established on
untreated antipsychotic
-Clinical features medications,
(FALTERED): yearly labs should
F= Fever be
A= Autonomic Instability considered.
(Tachycardia, HTN,
Diaphoresis)
L= Leukocytosis Elevated Prolactin
T= Tremor Levels
E= Elevated CPK
•
R= Rigidity (lead pipe)
E= Excessive sweating
D2 blockade in the
(diaphoresis) Tuberoinfundibular
D= Delirium (mental pathway= Hyper-
status changes) prolactin

Risk factors: young Common with

males early in treatment Risperdal
with high potency
antipsychotics, High Men=
doses, high potency, LAIs Gynecomastia,
erectile
Risk factors: Young males
early in treatment with dysfunction, low
high potency libido, galactorrhea
antipsychotics
Women =
12
Management galactorrhea and
1.D/C medication absence of
2.Supportive care menses, low
(hydration, IV benzos-for libido,
relaxation; cooling
galactorrhea
blankets)
3.Administer sodium
dantrolene, Management
bromocriptine, 1. Reduce or
amantadine discontinue med
4.ECT can be e3ective 2. Switch to a
di3erent mediation
3. If the above
techniques are not
feasible, add
Aripiprazole to the
regimen
Tardive Dyskinesia - reduce EPS Weight gain (appetite
Tardive= D2 Blockade -WEIGHT GAIN stimulant)
in the Nigrostriatal -DIABETES MEALtapazine
S/E: weight gain and sedation
Pathway =late MELLITUS
- Good for NH, cancer, HIV pts.
occurring ANTIMUSCARINIC - sedation
metabolic
Involuntary changes, sedation,
Choreoathetoid hypotension,
movements of face, anticholinergics,
mouth, lips (lip extrapyramidal -WEIGHT GAIN (20-
smacking) tongue (Jy (EPS), 30lbs)
catcher tongue) hyperprolactinemia -INCREASED
and other body parts (increased APPETITE
(facial grimacing, eye prolactin levels = -LACK OF ENERGY
blinking, trunk, limbs breast -DRY MOUTH
etc.) enlargement),
sexual dysfunction,
Occurs in patients who agranulocytosis,
have used neuroleptics seizures, cardiac
for months to years arrhythmias,
13
(Sooner in older adults)weight gain (like
30 lbs in 6 weeks) -
Risk factors: Extrapyramidal
older age, women, symptoms occur
patients with a3ective more commonly in
disorders, those medications
patients with substance that have high
abuse hx; FGA, duration dopamine
of txt, higher dose, blockade, such as
African American haloperidol.

Up to 50% of cases will

remit (without further
antipsychotic use)
Mostly irreversible

Management:
Dose reduction.
D/C med; switch to an
atypical antipsychotic;
Clonazepam, Clozapine
Amantidine, (Clozaril): Can
Tetrabenazine. cause
agranulocytosis
2017: First FDA (increased chance of
approved treatment infections) and bone
marrow suppression;
for TD
assumption of others
(Valbenazine=Ingrez meds tried Brst
za); Risperidone
Deutetrabenazine ( (Risperdal)
Austedo Quetiapine
) (Seroquel)
AIMS (Abnormal Olanzapine
Involuntary (Zyprexa,
Movement Scale) ZyprexaRelprevv):
testing initially then weight gain,

14
Q3-6 months diabetes

Risk factors: Ziprasidone

High doses, long (Geodon)
cause prolonged QT
duration, old age,
waveAripiprazole
women, hx of EPS, (Abilify)
substance abuse Paliperidone
(heavy smoking), (Invegasustania):
diabetes longest acting
Patient Education: injection form (1 inj
TD symptoms may for 6wks)
initially worsen
transiently as Iloperidone (Fanapt)
medication dosages are Lurasidone (Latuda):
lowered. can treat type 2
depressive dx
Consider switching
Asenapine (Saphris):
to Clozaril (Lowest sublingual form
risk of TD)

15
16
17
Lithium Valproic Acid (Depakote) Carbamazepine Lamotrigine
GOLD standard for bipolar dx Bipolar Dx: Rapid Cycling Tegretol (Carbamazepine): for Lamotr-ITCH-GINE
(MANIA) bipolar dx (DEPRESSION)
Good prognostic indicator for ClassiBcation: anticonvulsant
Lithium= episode pattern of
mania, depression and Good prognostic indicator for
euthymia Carbamazepine – rapid cycling
mania

Lithium: Narrow therapeutic Used: treat seizures, treat Use: treat seizures, nerve pain, Used to tx Bipolar DX
index(0.6-1.2 mEq/L); bipolar, prevent migraine treatment for bipolar disorder (depression)
Toxic >1.5; Potentially Lethal headaches (mania)
=>2.0 Lamictal)•100-200mg
Depakote Therapeutic No blood monitoring ( best
Early: Nausea, vomiting, level = 80-120 ug/ml Tegretol Therapeutic Level= 8 for some who won’t follow-
diarrhea, coarse tremors, Check level after 4-5 -12 mcg/ml up)
ataxia days
•S/E: dizziness, ataxia,
Rare= Depakote induced headache somnolence,
Late: Seizures, Coma, death S/E: Nausea, diarrhea, thrombocytopenia nausea, diplopia, itchy rash
Abdominal cramping, Elevation of liver enzymes
sedation, tremor, hair causing hepatitis
loss •Can cause idiosyncratic
Rare= Depakote induced Labs before initiating: liver injury
thrombocytopenia Pregnancy test, CBC, LFTs
Labs: CBC, LFTs
Regular Labs: CBC, LFTs RARE: Steven Johnson
Watch for s/s of Rare= Depakote induced Syndrome (life threatening
rash involving the
Hyperammonemia – thrombocytopenia
skin and mucus
confusion, membranes)
lethargy, abnormal Tegretol + Depakote = can •
posture - cause Hepatotoxic ***Start low and go slow
ataxia, seizure, agitation Staring lamotrigine rapidly
etc. can increase the risk of SJS.
–Check ammonia level To reduce start low and go
Brst. slow

18
 Tegretol + Depakote = Lamictal dose must be
can cause Hepatotoxic halved when taking
valproic acid

S/E: Dehydration, tremors, Side e3ects: TEGRETOL AUTO-INDUCTION

confusion, tired, nauseous o Hard on liver –
Mild symptoms: nausea, hepatotoxic (not for Tegretol level
vomiting, lethargy, tremor, and heavy drinkers) – watch range=remember auto-
fatigue (Serum
liver enzymes induction of its own
lithium concentration between
1.5-2.5 mEq/L)
o Teratogenic (not for metabolism may start 3
Moderate intoxication: pregnancy) – may test -5 days after initiation =
confusion, agitation, delirium, HcG level before meds to therefore decreases plasma
tachycardia, and ensure levels
hypertonia (serum lithium no pregnancy
concentration between 2.5-3.5 Downloaded by Ashley Can produce Ataxia even at
mEq/L) Hollins therapeutic doses
Severe intoxication: Coma, (ahollinsnp@gmail.com)
seizures, hyperthermia, and lOMoARcPSD|46315623
hypotension (serum o Ammonia levels
lithium concentration (less than
o Diarrhea, dizziness,
3.5 mEq/L)
drowsiness, hair loss,
blurred vision/double
vision,
changes in menstrual
periods, ringing in the
ears, tremor, weight
changes
· Side e3ects – when to
seek help:
o Chest pain, easy
bruising, unexplained
bleeding, fast or irregular
heartbeat,
swelling of hands & feet,
uncontrolled eye
19
 movements (nystagmus),
shivering,
rapid breathing, loss of
consciousness
Go to for type1 Bipolar Black box warning – TEGRETOL AUTO - INDUCTION
disorders only hepatic toxicity &
-Monitor lithium levels pancreatitis** Tegretol level range=remember
auto - induction of its own
closely o S/S Hepatic Damage
metabolism may start 3 -
-Therapeutic level is 0.8 (liver failure): abdominal 5 days after initiation = therefore
to 1.2 meq ( too little no pain, fatigue, loss of decreases plasma levels
e3ect; too much toxic appetite,
-Inverse relationship with water/electrolyte Can produce Ataxia even at
sodium (friendemies) imbalance, nausea, therapeutic doses
-Watch out for signiBcant bloating, confusion,
alteration to diet and yellow skin & eyes, bad
Juid consumption breath, bleeding,
**Ppl with impaired bruising, Japping hand
kidney functioln, CHF: tremor, itching, swelling
contraindicated—need to o S/S Pancreatitis: upper
watch Na+ intake bc they abdominal pain(may be
are so much alike sudden), back pain,
bloating,
Can cause EPS sympt oms fat in stool, indigestion,
♦ CNS depression nausea, vomiting, fast
♦ Orthostatic hypotension HR, weight loss, loss of
♦ May increase risk of DM appetite,
♦ Bet a-blockers increase sweating
e3ect s · Education: alcohol use,
of both drugs Tylenol, requirement for
♦ Avoid alcohol lab work, if you have
S/E epilepsy
Drowsiness ♦ Dizziness ♦ abruptly stopping can
Weight gain ♦ Dry mouth ♦ cause seizures, birth
N/ V/ D/ constipation ♦ defects associated with
Restlessness Depakote, check
Ammonia levels if there
20
 are cognitive changes.
- Hepatic damage risk
highest in Brst 6 months
of treatment
Factors that can increase Li+ Depakote vs. Lamictal Can cause idiosyncratic liver
levels •NSAIDS (e.g. •Concurrent dosing injury
ibuprofen) •Aspirin Depakote and Lamictal RARE: Steven Johnson
•Thiazide diuretics (CYP 450 strong inducers Syndrome (life threatening
•Dehydration (especially in and inhibitors) = Lamictal rash involving the skin and
the elderly) dose must be halved mucus membranes)•***Start
•Salt deprivation when taken with low and go slow
•Sweating (salt loss) Depakote •Depakote is a
•Impaired renal functioning mild-moderate CYP-450
•Ace Inhibitors inhibitor•Depakote
•Antihypertensives inhibits Lamictal =====
Slows metabolism of Teratogenic risks common with
Lamictal mood stabilizers
Teratogenic risks common =====Increased levels Carbamazepine (Tegretol):
with mood stabilizers of Lamictal in blood Neural tube defects
Lithium(Eskalith): Epstein ====Risk of
anomaly toxicity====Cut dose in
half

Teratogenic risks
common with mood
stabilizers:
Divalproex sodium
(Depakote):
Neural tube deBcits
-speciBcally spina biBda,
atrial septal defects, cleft
palate and
possible long-term
developmental deBcits

21
22